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<div class="col-md-3 appointment-right"> <a href="#" class="btn btn-default btn-default_2 pull-left" data-toggle="modal" data-target="#applyModal_1">Get in Touch</a> <div class="modal fade" id="applyModal_1" tabindex="-1" role="dialog" aria-labelledby="applyModalLabel" aria-hidden="true"> <div class="modal-dialog dialog_3"> <div class="modal-content"> <div class="modal-header"> <button type="button" class="close" data-dismiss="modal" aria-label="Close"><span aria-hidden="true">×</span></button> <h4 class="modal-title" id="myModalLabel"><div class="head_4"> <h3>Make An appointment Now</h3> <p>Fill the details to get appointment</p> </div></h4> </div> <div class="modal-body"> <form name="row" method="post" class="register"> <input type="text" name="name" id="name" placeholder="Name" required=""> <input type="text" name="email id" id="Email id" placeholder="Email id" required=""> <input type="text" name="mobile number" id="Mobile Number" placeholder="Mobile Number" required=""> <input class="date" id="datepicker" type="text" value="Appointment date" onfocus="this.value = '';" onblur="if (this.value == '') {this.value = 'Appointment date';}" required=> <textarea type="text" onfocus="this.value = '';" onblur="if (this.value == '') {this.value = 'Enter Message...';}" required="">Enter Message...</textarea> <input type="submit" onclick="myFunction()" value="Submit Now"> </form> </div> <!---start-date-piker----> <link rel="stylesheet" href="css/jquery-ui.css" /> <script src="js/jquery-ui.js"></script> <script> $(function() { $( "#datepicker" ).datepicker(); }); </script> <!---/End-date-piker----> </div> </div> </div> </div>